Healthcare Provider Details

I. General information

NPI: 1083911796
Provider Name (Legal Business Name): MICHAEL LEE PLUNKETT MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CURRY RD
TEMPE AZ
85281
US

IV. Provider business mailing address

497 E TONTO DR
CHANDLER AZ
85249-5306
US

V. Phone/Fax

Practice location:
  • Phone: 480-415-4848
  • Fax:
Mailing address:
  • Phone: 480-415-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09087
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: